Inspection on 30/04/07 for Howard Lodge

This inspection was carried out on 30th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Howard Lodge 23/02/06

Howard Lodge 14/07/05

Howard Lodge 23/11/04

Howard Lodge 03/06/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Howard Lodge Howard Lodge Road Dudbrook Brentwood Essex CM14 5TQ Lead Inspector Mr Trevor Davey Unannounced Inspection 30th April 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Howard Lodge DS0000018095.V338246.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Howard Lodge DS0000018095.V338246.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Howard Lodge Address Howard Lodge Road Dudbrook Brentwood Essex CM14 5TQ 01277 373603 01277 357297 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) St Michaels Homes Limited Ms Patricia Ryland Care Home 43 Category(ies) of Dementia (20), Old age, not falling within any registration, with number other category (43) of places Howard Lodge DS0000018095.V338246.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Personal care to be provided for one service user under the age of 65 years whose name is known to the Commission. 23rd February 2006 Date of last inspection Brief Description of the Service: Howard Lodge is a large established care home providing personal care and accommodation for 43 older people of whom, up to twenty may have dementia. It is privately owned and the providers have another home in the same area. It is a purpose built home providing single occupancy on two floor levels. Some of the bedrooms have en-suite facilities and others have small conservatories attached. The ground floor bedrooms with conservatories lead out to the large pleasant gardens. There is a passenger lift access to the upper floors. Communal accommodation consists of a choice of lounges, a quiet room, two dining rooms and a small chapel. The home is situated in a rural location with the nearest bus route, approximately one mile away. There is a large attractive garden for the residents’ use. Most of the downstairs rooms lead directly into this area. There is ample car parking to the front and rear of the property. All prospective residents are provided with a Statement of purpose and Service User Guide with information about the home. The current rate of fees as shown in the Pre-inspection questionnaire, range from £480 to £570 per week and there are additional charges for hairdressing, chiropody, newspapers and toiletries. Howard Lodge DS0000018095.V338246.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Key Inspection site visit covered a period of 11.25 hours and covered all Key standards. The Registered Manager and deputy together with other staff, residents, visitors and health care professionals were spoken with during the site visit. Their comments and contributions received were helpful in assisting the Inspector to compile the report. As part of the site visit, a tour of the premises took place and some of the personal care records and other official records within the home were also assessed. The management of the home had conducted their own survey and quality assurance exercise with residents and relatives. A summary of the feedback received was made available to the Inspector together with a copy of the action plan, which had been implemented by the home. Overall, the responses received by the Inspector and other information gathered by the home was complimentary and very positive regarding the standard of care and services provided. A pre-inspection questionnaire had also been submitted by the Registered Provider, which included other helpful information. What the service does well: The Home has been successful in demonstrating its pro-active approach to meeting the personal care needs of residents. Conversations with residents and visitors as well as feedback from surveys conducted by the home, show that people who use the service, feel they are treated with respect and dignity and that personal preferences are taken into consideration. Staff and residents were observed interacting well together and a sense of humour added to the warmth and homely atmosphere. Comments made to the Inspector included This is a good home and the meals are excellent. From the questionnaires, which were returned to the home, residents and relatives confirmed that the standard of personal care was good with general satisfaction in the way the staff team met and responded to individual care needs. Overall, care planning records and pre-assessment information was well documented and included all relevant information to help staff deliver appropriate care. As part of this process, residents and their families are given the opportunity of being involved in reviews and decisions relating to care needs and the support to be provided. The community nurse team and care Howard Lodge DS0000018095.V338246.R01.S.doc Version 5.2 Page 6 staff have an excellent working relationship with positive outcomes for residents where clinical needs are identified. The staff are good at maintaining a high standard of cleanliness and hygiene in the home and visitors confirmed that there were never any unpleasant odours. The management is good at responding to concerns and issues raised by users of the service and of implementing plans for improvement. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Howard Lodge DS0000018095.V338246.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Howard Lodge DS0000018095.V338246.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 & 6 People who use the service experience adequate quality outcomes in this area. Prospective users of the service do not have all the information they may need to make an informed choice about where to live. Pre-admission assessment details for care/health needs had been completed to give staff suitable information and to assure potential residents that their needs could be met. Intermediate care is not provided by the home. This judgement has been made using available evidence including a visit to the service. Howard Lodge DS0000018095.V338246.R01.S.doc Version 5.2 Page 9 EVIDENCE: The Home’s Statement of Purpose and Service User’s Guide were available and copies are given to residents. Information and details of the home’s services were set out in these documents, which are reviewed/updated periodically. Although the Home is registered for dementia care, there was no specific information, to show how the needs of this particular group of residents would be met and the additional services available. Additional details regarding terms/conditions and fees should also be included in the Service User’s Guide to give clearer information to residents and/or their representatives, as set out in an amendment to the Care Homes Regulations in September 2006. Pre-admission assessments had been completed which included relevant information and observations following initial visits to prospective residents. Details relating to personal care had been taken into account including dependency levels, feeding, washing/dressing, mobility, psychological and health requirements. Initial risk, moving and handling assessments had also been completed. From the samples of personal care records inspected, these included information submitted by social workers prior to admission. Where possible, family background and social history had been documented but in some cases, this information was limited. However, the Home has introduced life books and with the Co-operation of residents, further detailed information had been included. The response of surveys returned to the Home confirmed that initial inquiries were dealt with professionally and politely. Prospective residents were also invited to visit the home and the trial period was explained to them. A positive response also indicated that the assessment prior to admission was useful in assessing needs and answering queries. Howard Lodge DS0000018095.V338246.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 People who use the service experience good quality outcomes in this area. The personal care needs of residents were being met appropriately. Overall, care records were clearly documented and person centre. Medication administrative procedures were in place to ensure the safety and protection of residents. This judgement has been made using available evidence including a visit to the service. EVIDENCE: A selection of care plans and other case records were examined. This also involved sampling various information relevant to individual cases. There were good examples of clear recorded information, which was easy to follow and highlighted the identified needs of residents, expected outcomes for personal care and associated risk assessments. Care plans had been completed for all aspects of personal care, which included physical well-being, minimising risk of falls, medication, mental state and cognition. In other cases, care plans did Howard Lodge DS0000018095.V338246.R01.S.doc Version 5.2 Page 11 not include specific guidance as to what assistance should be provided to meet the identified need and from the sample checks made, some reviews had described the problems experienced but did not include further action which was required to deal with the issues identified and how these should be managed. Relatives spoken to were very pleased with the care provided by staff and in one case, they had also experienced this previously when another relative had stayed in the home. Relatives are invited by the home to attend for care reviews and where attendance is not possible, the management write to the relatives setting out a summary of care needs and how these are being met. They are also invited to give their responses. One such response expressed appreciation of the staff team’s hard work and assistance. Members of the community nursing team were also very complimentary regarding the standard of care provided, the effective management of toileting routines for residents and the good working relationship they enjoyed with the staff team. Although in some cases residents had been admitted to the home with pressure areas, these had healed and had not re-occurred. Staff had a good understanding of moving and handling techniques. During the course of the inspection, staff were observed to be caring, sensitive and competent in the way they were supporting residents in delivering personal care. Local doctors are very responsive and supportive to the home and regularly call in to see residents. Medication administrative records (M.A.R.) were being completed in accordance with agreed policies and procedures with doctors countersigning any changes in medication. A sample inspection was made of tablets and controlled drugs, which were properly accounted for. The management also carry out their own regular audit check to ensure accuracy. It was pointed out to staff by the Inspector, that as part of good practice, two staff signatures should support any hand written transcribing of medication. Positive feedback was received from the Home’s questionnaires indicating that the staff respect privacy, dignity and have the time to assist residents with their personal care. Howard Lodge DS0000018095.V338246.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 &15 People who use the service experience good quality outcomes in this area. People living at the home benefit from a range of activities to meet social, cultural and spiritual needs. Residents received wholesome and an appealing variety of meals. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Twenty-three questionnaires were returned to the home as part of their own quality assurance programme of which, fifteen were completed by relatives on behalf of residents with dementia. The feedback received so far as activities were concerned, showed that the majority were aware that entertainment and special events take place within the home and that residents were encouraged to participate. There was also an awareness that there are opportunities to go on outings, which are arranged, by the home. Almost all of the responses received showed there was an understanding that spiritual needs could be met including services and visits by priests of different denominations. The staffing establishment includes provision for a social activities organiser but at the time Howard Lodge DS0000018095.V338246.R01.S.doc Version 5.2 Page 13 of inspection, this post was vacant. During the inspection, a ‘singalong’ session was taking place which included visitors and staff who were interacting well with residents who attended. The sessions take place on a regular basis. A number of the residents were seen to be responding well to the stimulation provided by this kind of activity. It was noted that comments made by a relative in response to a review letter, suggested that residents should be encouraged to have greater participation in the home’s activities as well as opportunities for watching sport, television coverage of football and horse racing. There also needs to be specific social activity clearly intended to engage and stimulate residents with dementia. Feedback from the survey conducted by the home did show, however, that relatives were satisfied with the care provided to residents with dementia. The Home have also introduced lifebooks which has given staff additional opportunities to discuss with residents their background and social history. Information recorded was useful and detailed. Residents and visitors spoken to, confirmed that users of the service were able to follow their own chosen daily routines and had access to their rooms at any time. Families and visitors are able to regularly visit the home and are always made welcome. Positive comments were made regarding the quality and variety of food provided and records were available identifying residents individual choices as well as diabetic meals. Staff spoken to were also aware of special diet sheets. There were two choices available for main meals and pureed food was presented in an attractive manner. Kitchen staff are aware from care plans the preferences of residents who are consulted each day regarding their particular choice of meal. Staff were observed assisting and feeding residents in an appropriate manner during mealtimes. The on-site laundry facilities are well managed with clothing and bed linen being regularly cleaned to a high standard taking account of appropriate infection control procedures. Howard Lodge DS0000018095.V338246.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience good quality outcomes in this area. People who use the service are able to express their concerns and have access to a robust, effective complaints procedure, are protected from abuse and have their rights protected. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Some of the residents and relatives spoken with, were aware of the complaints procedure and were confident that they could approach the management should they have any concerns. Since the last inspection,two complaints had been recorded and details of the investigations, outcomes and action taken were on file. The home was able to demonstrate that the complaints procedure is effective. The majority of staff had received training and were aware of the policies and reporting procedures to follow relating to the prevention of harm to vulnerable adults. Howard Lodge DS0000018095.V338246.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People who use the service experience good quality outcomes in this area. The premises are well maintained to enable people who use the service to live in a safe, comfortable environment. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The premises were clean, hygienic and smelt fresh. Residents spoken with together with other health care professionals who regularly visit the home, confirmed that the home is maintained to a high standard. An ongoing programme of internal decorating takes place and since the last inspection, and additional dining room has been created to accommodate the needs of high dependent residents. From the survey returns completed by residents and visitors, all were very satisfied with the cleanliness, decoration and comfort provided in the communal areas. A smoking area has also been Howard Lodge DS0000018095.V338246.R01.S.doc Version 5.2 Page 16 created for residents and improved facilities for staff. Some of the residents spoke with, expressed to the Inspector how much they appreciated the gardens and grounds to which they had easy access. People who use the service like their rooms and are encouraged to personalise these areas. Housekeeping staff spoken with, stated that they follow a rigorous cleaning programme of floors and carpets and demonstrated that they had a good awareness of infection control procedures. The management were said to be pro-active in arranging for the repair and replacement of broken equipment. Howard Lodge DS0000018095.V338246.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 30 People who use the service experience adequate quality outcomes in this area. Staff in the home are trained, skilled and in sufficient numbers to support people who use the service. Recruitment policies and practices need to improve to ensure residents are adequately supported and protected. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The staff team are led by the Registered Manager and the deputy manager has specific responsibility for overseeing training and development. In addition, there are team leaders, senior care assistants and care staff. At the time of inspection, there were appropriate staffing levels to meet the needs of residents and names had been rostered showing the deployment of staff on different shifts. In addition, there are ancillary staff covering domestic, kitchen, laundry and maintenance duties. Three staff who are on awake duty provide night cover. There is a current vacancy for a social activities organiser. Howard Lodge DS0000018095.V338246.R01.S.doc Version 5.2 Page 18 Some of the staff spoken with were able to confirm that they had attended various courses. Training records were available which included dementia awareness, falls prevention, prevention of harm to vulnerable adults procedures, medication and manual handling. It is recommended that staff should receive additional training in understanding and caring for people who are diagnosed with Parkinsons and diabetes to ensure these needs are taken into consideration when delivering care. Some of the staff spoken with had a clear understanding of their roles and responsibilities. They confirmed that regular supervision took place and that management were approachable and supportive. According to the pre-inspection questionnaire, 32 of the staff team have obtained N.V.Q. Level 2 care. A check was made of the home’s recruitment records and it was noted that there were some staff working in the home where Criminal Record Bureau checks had not been completed and without two written references on file. If thorough recruitment procedures are not followed, this could place residents at risk. Feedback from survey forms completed and returned to the home as well as comments received by the Inspector, showed that staff were regarded as kind and helpful. Howard Lodge DS0000018095.V338246.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 People who use the service experience good quality outcomes in this area. The management and administration of the home is based on openness, respect and has effective quality assurance systems in place. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The Registered Manager and deputy have been in post for eight months. The Registered Manager has obtained the N.V.Q. Level 4 Registered Manager’s Award, is competent and able to discharge her responsibilities. The Deputy worked well with the Manager and is an N.V.Q Assessor. The Registered Provider works well and supports the management team to ensure the level of care is maintained to a high standard. Quality assurance monitoring takes Howard Lodge DS0000018095.V338246.R01.S.doc Version 5.2 Page 20 place, which involves the completion of questionnaires by residents and visitors. A report for 2006/2007 showing the outcome of the surveys together with the action plan implemented, was made available for inspection. The home was able to demonstrate that they are in regular touch with users of the service and comments received by the Inspector, show that the management are committed to looking at ways to improve communication as well as the service provided. Regular staff meetings take place and communication is both open and effective between the various staff groups. Minutes of meetings held were available for inspection. Assessments for a safe working environment had been completed which included the safe use of hoists and power equipment, as well as the safe use and control of substances hazardous to health. A maintenance book was being kept showing items requiring attention and the dates repairs or replacements were carried out. Health and safety policies were in place which are reviewed annually. The home has regularly notified the Commission for Social Care Inspection of any occurrences under Regulation 37 of the Care Homes Regulations. Howard Lodge DS0000018095.V338246.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 X X 3 Howard Lodge DS0000018095.V338246.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 6 Requirement The Registered Person shall keep under review and, where appropriate, revise the Statement of Purpose & Service User’s Guide; notify the Commission & service users of any such revision. This is to ensure users of the service are fully updated regarding the range of services provided & any fees involved. The Registered Person shall not employ a person to work at the care home unless they are fit & all recruitment checks have been completed. This refers specifically to Criminal Record Bureau checks & written references. This is to minimise the risk of harm and the safety of service users Timescale for action 31/07/07 2. OP29 19 (sched2) 30/06/07 Howard Lodge DS0000018095.V338246.R01.S.doc Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations The Registered Person should provide additional training to ensure all care plans & reviews contain specific details as to how & what action is required to meet identified need. This is to assist all staff to provide appropriate care/support which is consistent. The Registered Person should look into social occupational activities which engage residents requiring dementia care. This is to enhance the quality of life of this resident group. The Registered Person should provide training to promote greater understanding of Parkinsons & diabetes conditions. This is to assist staff in having awareness of the important care & medication issues involved. 2. 3. OP12 OP30 Howard Lodge DS0000018095.V338246.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Howard Lodge DS0000018095.V338246.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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